AccountId: 011433970860
ContactId: e00a56c8-bebb-4e02-bcd0-38c2373f13ba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 617479 ms
Total Talk Time (AGENT): 119880 ms
Total Talk Time (CUSTOMER): 210640 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/e00a56c8-bebb-4e02-bcd0-38c2373f13ba_20250624T13:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good morning. This is [PII]. I am calling for Prisma Health checking on claim status. Please be informed that this call is recorded for quality and training purposes.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, of course. It's [PII].
[AGENT][NEUTRAL] And the policy number for that patient?
[CUSTOMER][NEUTRAL] 01705313.
[AGENT][NEUTRAL] And what was the patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII], [PII].
[AGENT][NEUTRAL] And the date of service and bill charges?
[CUSTOMER][NEUTRAL] [PII] for $277.50.
[AGENT][NEUTRAL] OK. Uh, I've got several, um, charges for this date. So, do you have a CPT code or a procedure code that you could give me so I can make sure I'm pulling the right one?
[CUSTOMER][NEUTRAL] Oh yeah, I, we have here procedure codes.
[CUSTOMER][NEUTRAL] 7,356,073,120 and 73,620.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, it looks like we received it like 5 times, so let me figure out which one is.
[AGENT][NEUTRAL] Or 6 times actually.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Actually, upon checking on our system here, it looks like um we have received a copy of the EOB for this wherein it was denied for um needing.
[CUSTOMER][NEUTRAL] Um, additional information for adjudication. I just wanted to know, um, what information is being needed here?
[AGENT][NEUTRAL] You have the claim number for that?
[CUSTOMER][NEUTRAL] I have here 337.
[CUSTOMER][NEUTRAL] 6742.
[AGENT][NEUTRAL] And we were requesting the primary explanation of benefits.
[AGENT][NEUTRAL] No, we've received it 5 other times. Let me see if it's, if we ever got it.
[CUSTOMER][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] It looks like we just got duplicates 5 more times. So do you have the primary EOB?
[CUSTOMER][NEUTRAL] Yeah, on our system here it looks like on [PII] it has been mailed along with the EOB and I'm so sorry, um, this, this claim was processed a secondary, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Condi. And OK. And you're needing the primary EOB from?
[AGENT][NEUTRAL] Yes, it's secondary.
[AGENT][NEUTRAL] Uh, we had Blue Choice on file.
[CUSTOMER][NEUTRAL] Blue Choice.
[CUSTOMER][NEUTRAL] Primary EOP.
[CUSTOMER][NEUTRAL] From Blue Choice.
[CUSTOMER][NEUTRAL] All right. Let me just double check on this because on our system it shows here primary is um American Public Life and we have Blue Choice of the secondary. Let me just double check on this.
[AGENT][NEUTRAL] Yeah, we're not, we're not primary.
[CUSTOMER][NEUTRAL] And yeah, may I.
[CUSTOMER][NEUTRAL] Uh-huh, OK, um, may I also know the process date, please?
[AGENT][NEUTRAL] Um, one of the last ones processed was requesting again primary explanation of benefits.
[AGENT][NEUTRAL] That was
[AGENT][NEUTRAL] I received 1 1124, process 116 24.
[CUSTOMER][NEUTRAL] OK and then um you received several uh claims after that, but um the primary EOB is not in is not attached, is that correct?
[AGENT][POSITIVE] That's correct. Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right and.
[CUSTOMER][NEUTRAL] Let me double check OK and can I also have the address as to where it can be submitted?
[AGENT][NEUTRAL] Uh, the claim's mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And it's [PII].
[AGENT][NEUTRAL] [PII] and then we can, we have a fax number too if you'd like to fax it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, fax number is [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for that. I also would like to ask um is there any is there any timely filing limit for us to submit the information that you need?
[AGENT][NEGATIVE] No, there's no timely filing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, and before we proceed, I actually have one more um claim here one for claim for this uh the same patient. Are you able to assist me with one more?
[AGENT][NEUTRAL] Yes, what's the date of service?
[CUSTOMER][NEUTRAL] Hold on, let me open it up.
[CUSTOMER][NEUTRAL] All right. So for the next, oh hold on.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][POSITIVE] That's great.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Alright, so for the next one I have date of service [PII]. Total charge amount is $65.
[AGENT][NEUTRAL] OK, let's see
[CUSTOMER][NEUTRAL] OK. So upon checking on our system here, it looks like we also received an EOB. Let me provide you with the um
[CUSTOMER][NEUTRAL] Claim number.
[AGENT][NEUTRAL] 342-064-8.
[CUSTOMER][POSITIVE] 34. Yeah, that's correct.
[AGENT][NEUTRAL] OK. Yes, that one, we did not receive the primary EOB.
[CUSTOMER][NEUTRAL] Oh, it's just the same.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] With the previous one.
[CUSTOMER][NEUTRAL] And yeah, I already have the information here and for that one, can I also have the process date please?
[AGENT][NEUTRAL] Uh, that one is.
[AGENT][NEUTRAL] Sorry, I clicked out of it and then.
[AGENT][NEUTRAL] OK, I received 217 process [PII].
[CUSTOMER][NEUTRAL] [PII]. All right. Got it here. I already have the information as well. And uh
[CUSTOMER][NEUTRAL] Yeah, lastly I'll just be needing a call reference number please.
[AGENT][NEUTRAL] Uh, call reference is my name, [PII], first initial to last name [PII], and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got it. [PII], thank you so much for your time and for assisting me today and you have a great day.
[AGENT][POSITIVE] Thanks for calling APL. You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.